UNASSIGNED: We present a case of idiopathic azygos vein aneurysm (AVA) and describe its radiological features. Clinicians should be aware of the imaging findings to avoid the risk of bleeding caused by biopsy.
METHODS: An asymptomatic 46-year-old woman was found to have an abnormal shadow on a chest computed tomography (CT) scan during a medical checkup. Plain CT revealed a well-defined, homogeneous mass on the posterior side of the right main bronchus. Contrast-enhanced CT revealed a mass with marked enhancement pointing to a vascular structure. Three-dimensional reconstruction showed that the mass was connected to the azygos arch, and inflow to and outflow from the azygos vein was detected. Subsequently, video-assisted thoracic surgery was performed.
UNASSIGNED: Patients with idiopathic AVA often present with accidental findings of a mediastinal or lung mass on a chest radiographs or CT scans, which can be mistakenly diagnosed as a paratracheal tumor, bronchial cyst, or posterior mediastinal tumor. Needle biopsy should be avoided due to the risk of massive bleeding. During the evaluation of thoracic malignancies, AVAs should be considered in the differential diagnosis, especially in area of the right tracheobronchial angle or right upper or posterior mediastinum. Three-dimensional reconstruction can help surgeons to clarify the disease diagnosis.
CONCLUSIONS: Imaging findings combined with enhanced CT and three-dimensional reconstruction are useful for diagnosing AVAs.

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BACKGROUND: With the increasing availability of chest computed tomography (CT), the detection of small pulmonary nodules has become more common, facilitating the development of lung segmental resection. However, anatomical variations of the bronchi are common, particularly in the right upper lobe of the lung.
METHODS: We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung. Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe. However, intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe, further showing that the bronchi of the posterior segment of the right lung opened into the bronchus intermedius. The procedure was completed uneventfully. Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius.
CONCLUSIONS: This rare case highlights the importance of 3D reconstruction to guide accurate segmentectomy in patients with anatomic variations.

Cases of a retroperitoneal tumor with double inferior vena cava (IVC) are rarely reported. The present report documents a case of a retroperitoneal lymphoma with double IVC, and discusses its embryological, clinical and radiological significance. In addition, previous cases of a double IVC are reviewed. In the present report, a 52-year-old male patient was hospitalized for a retroperitoneal lymphoma tumor and double IVC. CT urography was performed, whilst a three-dimensional visualization model was also established based on CT data, to reveal a retroperitoneal tumor with double IVC. The present case involved a double IVC with interiliac vein, which was type 2b from the left IVC. The retroperitoneal tumor was identified to be a lymphoma measuring 116x83 mm by percutaneous puncture biopsy. Surgical treatment is generally not recommended for lymphoma. Therefore, this patient was transferred to the Hematology Department for treatment according to the lymphoma management guidelines. The size of the tumor was reduced after chemotherapy during the patient\'s follow-up. In conclusion, the three-dimensional visualization model can directly and accurately present the anatomical features of the double IVC and its surrounding tissue structure. In addition, variations in the features of IVC can have important clinical significance. It is also important for surgeons, interventional radiologists and clinicians to understand such abnormalities in anatomical features to avoid misdiagnosis and reduce the occurrence of serious intraoperative complications.

BACKGROUND: Azygos vein aneurysms (AVAs) are extremely rare. The majority of patients have no obvious clinical symptoms, so they are found by physical examination or by chance. There is limited clinical treatment experience that can be referred to, and there are no clear guidelines or research evidence standardizing the surgical and interventional therapy. Here, we report a patient with idiopathic AVA whose three-dimensional reconstruction of the tumor was completed before surgery. On the basis of three-dimensional reconstruction, single-port thoracoscopic resection of the AVA was successfully completed and reported for the first time. The previously reported cases are summarized to provide guidance for the diagnosis and treatment of patients with AVAs.
METHODS: A 56-year-old man was transferred to our hospital due to \"dysphagia\". The diagnosis of AVA was made after enhanced computed tomography, gastroscopy, fiberoptic bronchoscopy, and three-dimensional reconstruction. Congenital weakness or degenerative changes causes the vein walls to be extremely thin that the AVA had the risk of ruptur. Furthermore, the patient had symptoms of dysphagia, he received single-port thoracoscopic surgery. After the operation, his dysphagia disappeared. The postoperative pathology confirmed hemangioma. The patient was discharged 3 days after surgery without any complications.
CONCLUSIONS: AVAs are rare. Preoperative three-dimensional reconstruction can greatly help surgeons clarify the disease diagnosis, formulate the surgical plan, avoid damage to the surrounding vital organs, and reduce intraoperative bleeding. Thoracoscopic surgery to remove AVAs is difficult and has a high risk of bleeding, while more minimally invasive single-port thoracoscopic surgery is also safe and effective for the treatment of AVAs.

BACKGROUND: The incidence of multiple primary lung cancer (MPLC) in China is 0.52%-2.45%. Most primary lung cancer cases have reported two lesions or three in rare cases. We report a rare case of bilateral simultaneous multiple primary lung adenocarcinoma of four different genotypes.
METHODS: A 58-year-old woman was admitted to our hospital on June 29, 2021, and upon physical examination, four multiple pulmonary nodules were identified in both lungs. Further computed tomography (CT) images revealed the presence of ground glass nodules, predicted to be high-risk cancer lesions by artificial intelligence. With the guidance of three-dimensional reconstruction of preoperative CT images, the nodules were resected under thoracoscopy. Postoperative pathological investigation revealed that the nodule types were adenocarcinoma in situ, invasive alveolar adenocarcinoma, and microinvasive adenocarcinoma. The excised nodules were further sequenced using high-throughput sequencing (semiconductor sequencing method) of 26 lung cancer genes to confirm that the four lesions were not homologous. The patient was discharged on postoperative day 8, that is, on July 15, 2021. One month later, she returned to the hospital for follow-up and reexamination. Chest CT examination showed that she had recovered well, and no obvious exudation and effusion were found in both pleural cavities. Evaluation of postoperative pulmonary function showed that her forced vital capacity was 1.40 L (preoperative value, 2.27 L) and forced expiratory volume was 1.24 L (preoperative value, 2.23 L).
CONCLUSIONS: The surgical plan for multiple pulmonary nodules should be carefully considered. For carefully selected patients with concurrently occurring multiple lung nodules in both lungs, sublobectomy is a safe and feasible plan for concurrent bilateral resection of the lesions. Genetic sequencing is necessary for MPLC diagnosis and treatment.

Primary thymic small cell neuroendocrine carcinoma (SCNEC), which possesses a more aggressive biological behaviour, including invasion of proximal structures, local recurrence, and distant metastasis, is extremely rare. According to a previous literature report, only a few patients with this disease have been reported, compared to patients with distant metastasis of bones, lungs, spleen, liver, and adrenal glands (1, 2). The report data suggest that SCNEC is a highly malignant tumour compared to most other tumours of the human body. In this study, we presented the case of a patient who underwent surgery guided by three-dimensional reconstruction modelling before the operation. We were fully prepared for the resection of this tumour using three-dimensional reconstruction modelling, even after reading the computed tomography (CT) images that showed a closed relationship with the pericardium, the vein of the right middle lung lobe, and the phrenic nerve. All these features demonstrate that SCNEC is highly malignant. To date, there are no procedural reports for three-dimensional reconstruction modelling in malignant thymus tumours.

The maxillary first premolar commonly has one or two root canals; the presence of three canals is rare. These root canals are easily missed during treatment, resulting in failure of root canal therapy. The present report describes a case in which three root canals in the maxillary first premolar were diagnosed by cone-beam computed tomography. The herein-described patient was successfully treated using three-dimensional reconstruction technology to determine the form and direction of curvature of the root canals.

BACKGROUND: The azygos lobe (AL) combined with partial anomalous pulmonary venous return (PAPVR) is comparatively uncommon as well as in radical surgery for right lung cancer.
METHODS: We herein present an extremely rare case of lung cancer coexisting with AL and asymptomatic PAPVR, which was diagnosed with preoperative contrast three-dimensional reconstruction and received radical surgery by thoracoscopy. During the surgery, we preserved azygos vein successfully and found a split type of PAPVR in right upper pulmonary vein.
CONCLUSIONS: AL combined with PAPVR may cause confusion on the vascular separation and disconnection of the right pulmonary hilar. However, preoperative 3D reconstruction is more conducive to the correct performing of this type of surgery.