Hyperparathyroidism presented as multiple pulmonary nodules in hemodialysis patient status post parathyroidectomy:A case report

BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.Ectopic parathyroid adenomas occur as well,with cases involving various sites,including the mediastinum,presenting in varying frequencies.Secondary hyperparathyroidism develops in the context of chronic kidney disease,primarily due to vitamin D deficiency,hypocalcemia,and hyperphosphatemia.It is frequently diagnosed in patients undergoing dialysis.This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis(HD).CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis.Radiographic imaging revealed multiple nodules in both lungs,with the largest measuring approximately 1.35 cm.Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue.After tumor resection surgery via videoassisted thoracic surgery with wedge resection,the patient was discharged in stable condition and in follow-up her symptoms showed improvement.CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing postparathyroidectomy HD,highlighting diagnostic challenges and a positive outcome from tumor resection surgery.

Formation of a rare curve-shaped thoracolith documented on serial chest computed tomography images:A case report

BACKGROUND Thoracolithiasis is a rare benign condition that manifests with one or more small nodules in the pleural cavity.In most cases,it is asymptomatic and found incidentally on chest imaging or during thoracic surgery.The thoracolithiasis formation process is rarely documented.Herein,we present a case of a rare,large,curve-shaped thoracolith,the formation of which was documented on serial computed tomography(CT)images.CASE SUMMARY A 46-year-old male patient who denied any prior systemic disease was evaluated due to intermittent right-sided lateral chest pain lasting for a year.Chest radiography and CT revealed a circumscribed calcified nodule measuring 3.5 mm in the right lower lung lobe.Nodule biopsy revealed fungal infection,which was treated with antifungal medication.After 2 years of follow-up,the patient developed intermittent chest discomfort caused by pleural adhesions,and underwent video-assisted thoracic surgery with pneumolysis.Postoperatively,he developed empyema,which fully resolved with antibiotic therapy.Thereafter,he was followed up at the outpatient clinic and underwent chest CT twice per year.Over time,we observed thickening of the right distal pleura near the lower posterior mediastinum,and several sporadic calcified nodules with gradually increasing intensity,which eventually merged into a single calcified curve-shaped thoracolith measuring approximately 9 cm in length during the 5-year follow-up.CONCLUSION This study documented the formation of a rare thoracolith shape observed for the first time.

Intrathoracic caudate lobe of the liver:A case report and literature review

Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.

Rare solitary splenic metastasis from a thymic carcinoma detected on fluorodeoxyglucose-positron emission tomography:A case report

BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated splenic metastasis can occur but is very uncommon.To date,only 2 cases of splenic metastases from thymic carcinoma have been reported.CASE SUMMARY A 45-year-old man presented with chronic cough,dyspnea,persistent hoarseness and unintentional weight loss 17 kgs in 6 mo.Neck magnetic resonance imaging revealed a large,lobulated,soft-tissue mass measuring 5.4 cm×6.6 cm×3.8 cm which involved the left superior mediastinum and supraclavicular fossa.Chest computed tomography(CT)revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery,right and left carotid arteries,and left subclavian artery in the mediastinum.A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey.The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum,over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa.CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis.The patient was diagnosed of thymic carcinoma,cT2N2M1b,stage IVb.CONCLUSION A fluorodeoxyglucose(FDG)-positron emission tomography(PET)scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging.Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.

Diagnosis and management of glandular papilloma of lung:A case report

BACKGROUND Solitary respiratory papilloma is a rare epithelial tumor that can be categorizedinto multiple subtypes depending on tumor location,histological presentationand number.The glandular type is the rarest,with only 30 cases available withinthe field.Hence,information on its identification and treatment is limited.In thisreport,we discuss the diagnostic strategy and management of glandularpapilloma,along with a review of the literature.CASE SUMMARY We describe a male 44-year-old nonsmoker who presented with a persistentcough and recurrent pneumonia,which he had experienced for over 2 years.Asolitary pulmonary nodule with an endobronchial lesion was found via computedtomography of the chest.After a biopsy was obtained,no definite diagnosiscould be made.Glandular papilloma of the lung was confirmed via videoassistedthoracoscopic anatomic resection of the right lower lobe of the lung.Thepatient remained disease-free after 6 mo follow up.CONCLUSION Minimally invasive surgery is feasible for the surgical resection of endobronchialglandular papilloma.Although rare,glandular papilloma should be consideredin patients with infection or endobronchial lesions.

Traumatic giant cell tumor of rib: A case report

BACKGROUND Giant cell tumor(GCT)of the anterior rib origin is extremely rare.We report the first case of trauma-induced GCT of the rib.CASE SUMMARY A 22-year-old female developed a mass over the right anterior chest wall with pain 3 mo after a falling injury with blunt trauma of the right chest wall.Chest computed tomography(CT)showed a tumor originating from the right 6th rib with bony destruction,and a CT-guided needle biopsy revealed a GCT.We completely resected the tumor with chest wall and performed reconstruction.The pathological diagnosis was GCT of the bone.Twelve months after surgery,no signs of recurrence were observed.CONCLUSION GCT of the rib after trauma has not been reported.Meticulous history-taking and image evaluation are essential for the differential diagnosis of unusual chest wall tumors.

Role of positron emission tomography in primary carcinoma ex pleomorphic adenoma of the bronchus: A case report

BACKGROUND Primary carcinoma ex pleomorphic adenoma arising from the tracheobronchial system is rarely reported.CASE SUMMARY We present a patient with primary carcinoma ex pleomorphic adenoma of the bronchus and review the associated literature for further comparison,including age,clinical manifestations,and diagnostic process.This patient had no history of neoplasms of the salivary gland.CONCLUSION Positron emission tomography played an important role in the staging work-up of primary carcinoma of ex pleomorphic adenoma.Long-term follow-up was necessary for further prognosis analysis.

Chest pain in a heart transplant recipient:A case report

BACKGROUND Heart transplantation is recommended for the treatment of patients with refractory heart failure.Chest pain after heart transplantation is usually considered noncardiac owing to the denervated heart.However,data from case reports on tacrolimus-induced achalasia after heart transplantation are limited.We aimed to present a case of tacrolimus-induced achalasia that developed after heart tran-splantation,which was successfully relieved by laparoscopic Heller myotomy.CASE SUMMARY A 67-year-old man with a history of Type 2 diabetes mellitus,hyperlipidemia,and dilated cardiomyopathy had congestive heart failure following orthotopic heart transplantation with tacrolimus treatment 12 years ago.At the 10-year follow-up after the heart transplantation,the patient presented with persistent cough,dysphagia,heartburn,and retrosternal chest pain lasting for 2 wk.Upper endoscopy revealed no specific findings.Two years later,the patient experienced the same symptoms,including chest pain lasting for 4 wk.Esophagogram and manometry confirmed the presence of achalasia.Previous reports showed that discontinuing calcineurin inhibitor(CNI)treatment and endoscopic botulinum toxin injection could treat CNI-induced achalasia.Owing to the risk of rejection of the transplanted heart and considering the temporary benefits of botulinum toxin injection in achalasia,the patient underwent laparoscopic Heller myotomy.Dysphagia was relieved without complications.Eight months later,he had no signs of recurrence of the achalasia.CONCLUSION In transplant patients with chest pain and gastrointestinal symptoms, CNIinducedachalasia may be one of the differential diagnoses. Esophagogram/manometry is useful for diagnosis.

Three-dimensional image simulation of primary diaphragmatic hemangioma: A case report

BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional(3D)simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.CASE SUMMARY A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.CONCLUSION In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.