Cases reported "Aortic Aneurysm, Thoracic"

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1/29. Saccular descending thoracic aortic aneurysm with dysphagia.

    A 76 year old woman had suffered from chest pain, back pain, and dysphagia for 8 months. She was diagnosed as having a thoracic aortic aneurysm by chest X-ray and chest enhanced computed tomography. Simultaneously, severe dysphagia developed. Chest enhanced computed tomography and chest aortic aortography at our hospital demonstrated a saccular descending thoracic aortic aneurysm. Esophagography demonstrated that the esophagus was compressed by the aneurysm; therefore, a graft replacement for the saccular descending thoracic aortic aneurysm was performed on February 17th, 1998. A left sided 6th intercostal approach was made, and graft replacement for the aneurysm using a 22 mm Hemashield prosthetic graft was performed under temporary bypass from the thoracic aorta just distal to the left subclavian artery and to the left femoral artery. The postoperative course was uneventful, the severe dysphagia improved dramatically, but a pleural effusion of 1000 ml collected 3 weeks after the operation. Surgical cases of saccular descending thoracic aortic aneurysm with dysphagia are rare, and with this in mind, we report this case to the the medical literature.
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ranking = 1
keywords = esophagus
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2/29. Combined resection of the thoracic esophagus and thoracic descending aorta.

    We conducted combined resection of the thoracic esophagus and thoracic descending aorta in 2 patients, one with advanced esophageal cancer with aortic invasion and the other aortoesophageal fistula caused by a false aortic aneurysm. Combined resection of esophageal tumor and adjacent involved organs was conducted in 14 patients with A3:T4 esophageal cancer but none survived 3 years and resecting tumor-invaded organs did not improve patient survival. One major problem of combined resection of the esophagus and aorta is contamination of the posterior mediastinum. In 1 patient, 2-stage surgery for the esophagus and in situ aortic replacement was conducted to reduce operative risk and avoiding infection of the prosthetic vascular graft. With thoracic descending aortic aneurysm adjacent to the esophagus on the increase, cardiovascular surgeons should prepared to undertake combined resection of both the aorta and esophagus.
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ranking = 9
keywords = esophagus
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3/29. Aortoesophageal fistula caused by aneurysm of the thoracic aorta: successful surgical treatment, case report, and literature review.

    Aortoesophageal fistula induced by atherosclerotic thoracic aortic aneurysm is rare, but is usually a fatal disorder, with few survivors reported. We report the case of a 72-year-old man with aortoesophageal fistula successfully treated in a two-stage operation. In the first stage, we performed resection and replacement of the aortic aneurysm with a prosthetic graft in situ, esophagectomy, cervical esophagostomy, and jejunostomy. After the patient recovered well postoperatively, a transmediastinal retrosternal interposition of the stomach was performed, with esophagogastroanastomosis in the cervical area, to re-establish the gastrointestinal tract. We include a discussion of the causes, diagnostic approach, management of the aorta and esophagus, and review of the literature.
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ranking = 1
keywords = esophagus
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4/29. Idiopathic submucosal hematoma of esophagus complicated by dissecting aneurysm, followed-up endoscopically during conservative treatment.

    Submucosal hematoma of the esophagus is encountered as a rare complication of endoscopic treatment for esophageal varices, but is seen more often with the increasing frequency of endoscopic applications. Idiopathic submucosal hematoma is a rarer event and in most cases sudden intense vomiting has been postulated as its cause. We report here the case of such a patient whose condition was complicated by a dissecting aneurysm. During conservative treatment, careful follow-up was required to differentiate the submucosal hematoma from an aorto-esophageal fistula.
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ranking = 5
keywords = esophagus
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5/29. aortic aneurysm involving a right-sided arch complicating aortobronchopulmonary and aortoesophageal fistula.

    A 66-year-old man with hemoptysis, chest pain, fever, and hoarseness was admitted to our department. A right-sided aortic arch and three aneurysms in the proximal arch, distal arch, and descending aorta were confirmed by aortography and surgery. Fistula formations were discovered between the proximal arch aneurysm and the right upper lobe (aortobronchopulmonary fistula: ABF), and between the descending aorta and the esophagus (aortoesophageal fistula: AEF). Concomitant ABF and AEF are very rare. Aortopulmonary and/or aortoesophageal fistula complicated by a right-sided aortic arch have not been previously reported.
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ranking = 1
keywords = esophagus
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6/29. Successful management of an aortoesophageal fistula resulting from an aneurysm of the thoracic aorta with a covered stent.

    Aortoesophageal fistula (AEF) is a relatively rare but life-threatening cause of upper gastrointestinal bleeding. There have been only a few survivors previously reported. There are controversies particularly regarding the treatment of the esophagus and postoperative infections. We report a case of an elderly man with an aortoesophageal fistula resulting from a thoracic aortic aneurysm. We managed the replacement of the aorta using a prosthetic graft, and an omentopexy for the fistula of the esophagus. For the treatment of leakage of the esophageal fistula, we successfully used a covered stent. This is the first report of the management of AEF using a covered stent.
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ranking = 2
keywords = esophagus
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7/29. Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta.

    A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.
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ranking = 1
keywords = esophagus
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8/29. Successful surgical treatment for an aortoesophageal fistula due to a descending aortic aneurysm.

    The patient was a 68-year-old man who consulted another hospital with a chief complaint of dysphagia, and was referred to our hospital based on a suspicion of esophageal submucosal tumor. However, the patient was emergently admitted due to hematemesis and hypotension, which occurred immediately after the acquisition of computed tomographic (CT) images for further examinations at the outpatient clinic. Contrast-enhanced chest CT demonstrated a thoracic aortic aneurysm measuring 45 mm in maximal diameter, in addition to pneumatization adhering to mural thrombus, which appeared to be the esophagus. Upper gastrointestinal endoscopy also demonstrated ulcerative lesions accompanied by coagulations in the middle thoracic esophagus. Therefore, emergency surgery was performed based on a diagnosis of an aortoesophageal fistula due to a descending aortic aneurysm. Graft replacement was performed under partial extracorporeal circulation, followed by total thoracic esophagectomy, esophagostomy, and gastrostomy after weaning from extracorporeal circulation. This study reports the course of a patient with an aortoesophageal fistula due to a thoracic aortic aneurysm whose life was successfully saved by emergency surgery, together with literature.
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ranking = 2
keywords = esophagus
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9/29. Rare case of heart failure caused by compression of the left atrium by a thoracic aortic aneurysm.

    A 61 year old patient was found to have an aneurysm extending from the aortic root to the suprarenal region. He underwent first stage surgery with aortic root and arch replacement, prosthetic aortic valve replacement, and coronary artery bypass grafting. Four weeks later, he presented with breathlessness and signs of heart failure and pleural effusion. Computed tomography showed that the left atrium was compressed between the aortic aneurysm posteriorly and the left ventricle and sternum anteriorly. Obstruction of the superior vena cava, bronchus, oesophagus, and rarely right atrium by an aortic aneurysm has been described before but presentation with left atrial compression has not been reported.
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ranking = 1
keywords = esophagus
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10/29. Esophageal and bronchial perforations after thoracic aortic aneurysm replacement: successful repair with covered metallic stents.

    Esophageal and bronchial perforations are rare but potentially fatal complications of descending thoracic aortic aneurysm replacement. This report presents a 67-year-old man with both esophageal and bronchial perforations that occurred after descending thoracic aortic aneurysm replacement. Surgical repair was performed, but the lesions perforated again. Two covered metallic stent prostheses introduced into both the esophagus and left main bronchus led to the improvement of mediastinitis by sealing the perforations. To our knowledge, this is the first report describing successful treatment for esophageal and bronchial perforations using covered metallic stents. Placement of covered metallic stents can be an option for the treatment of patients with esophagorespiratory tract perforations, especially those who are in critical condition.
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ranking = 1
keywords = esophagus
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