Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.
Chest Pain ; Cough ; Deglutition Disorders ; Drainage* ; Endosonography ; Esophagus ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Respiratory Sounds ; Ulcer

PURPOSE: Perigraft seroma and excessive fluid leaks are well known complications after the use of expanded polytetrafluoroethylene(ePTFE, Gore-Tex(R)) graft. The purpose of this study is to evaluate the effectiveness of precoating the grafts with fibrin glue in the patients underwent a modified Blalock-Taussig shunt. METHODS: Among 51 consecutive infants underwent modified Blalock-Taussig shunt between June 2000 and August 2003, 49 patients underwent 53 shunt procedures through thoracotomy were included for analysis. Their median age was 0.9 months(2 days-5.9 months), median body weight was 3.5(2.2-7.9) kg. The ePTFE grafts precoated with fibrin glue were used in 20 procedures. Perioperative variables of the precoated group were compared with those of a control group(n=33) using t-test and Fisher's exact test. RESULTS: There was no operative mortality in the both groups. No significant difference between the groups could be found in the preoperative variables, postoperative morbidity, and the incidence of perigraft seroma, which developed only in 1 case in the control group. The size of the grafts was significantly smaller in the precoated group(P<0.01). The total amount of pleural drainage per body weight of the precoated group was significantly less than that of the control group(19.7+/-25.2 versus 5.5+/-4.9 mL/kg; P<0.01). CONCLUSION: Precoating an ePTFE graft with fibrin glue may reduce perigraft leak after a modified Blalock-Taussig shunt, although the impact of the size of the graft used and the native pulmonary artery requires further investigation.
Blalock-Taussig Procedure ; Blood Vessel Prosthesis ; Body Weight ; Drainage ; Endoleak* ; Fibrin Tissue Adhesive ; Humans ; Incidence ; Infant ; Mortality ; Polytetrafluoroethylene* ; Postoperative Complications ; Pulmonary Artery ; Seroma ; Thoracotomy ; Tissue Adhesives ; Transplants

Early esophageal cancer is defined as a tumor invading the mucosa with or without lymph node or distant organ metastasis. In the current guidelines for early esophageal cancer, absolute indication for endoscopic resection include lesions limited to the epithelium or lamina propria mucosa not exceeding two-thirds of the circumference, and relative indications include lesions limited to the muscularis mucosa or the upper third of the submucosal layer and not accompanied by clinical evidence of lymph node metastasis. After endoscopic submucosal dissection for early esophageal cancer, locally recurrent cancer can occur, especially in the case of incomplete resection. Here, we report a rare case of a submucosal tumor-like recurrence after endoscopic resection of early esophageal cancer.
Endosonography ; Epithelium ; Esophageal Neoplasms ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Recurrence

BACKGROUND: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. METHODS: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. RESULTS: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). CONCLUSION: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.
Humans ; Lung ; Lung Injury ; Pneumothorax* ; Retrospective Studies ; Rupture ; Thoracic Surgery, Video-Assisted