Successful removal of giant primary osteosarcoma in the anterior mediastinum invading the superior vena cava and right lung with artificial blood vessel reconstruction

Abstract Introduction Thymoma is the most common primary neoplasm of the anterior mediastinum. Most invasive thymomas are limited to the pericardium. Only few cases of transcaval extension with intracardiac involvement have been reported. Case report We present the case of a 15-year-old boy with previous history of infectious cerebelitis without neurologic sequelae. He presented with interscapular pain for 6 weeks (not improving with symptomatic therapy) and fever for 3 days. On admission, chest radiograph exhibited an opacification in the right hilum (Figure A). He was discharged with antibiotic prescription for presumptive pneumonia. Due to persistence of complaints he was revaluated after 5 days. Signs of superior vena cava (SVC) syndrome were noted. A computerized tomography showed a large soft tissue mass of the anterior mediastinum, in right antero-lateral topography, measuring 12.5x10x9.5 cm with central calcification and extension to the right lung (Figure B). Transthoracic and transoesophageal echocardiography showed an anterior mass compressing the pulmonary artery branch (PA) and SVC with marginal invasion of the right atrium (RA) (Figure C and D). Cardiac MRI confirmed a large mass of the anterior mediastinum with extension and invasion of the right superior lobe, invasion of the superior vena cava with extension into the RA (Figure E). Transthoracic core-needle biopsy was performed and histopathological diagnosis confirmed an invasive thymoma. The case was discussed at joint cardiothoracic surgery and oncology multidisciplinary meeting and it was agreed to neoadjuvant chemotherapy regimen followed by surgery. Intraoperatively, a large tumor invading the SVC and proximal RA was found, in accordance with the echocardiographic and MRI findings. Due to unforeseen metastatic implants on the adventitia of the main PA and ascending aorta, resection of the tumor was not performed. Palliative decompression of the venous system was performed with interposition of a ringed vascular prosthesis between the left brachiocephalic vein and the right atrial appendage. (Figure F). The patient received postoperative radiotherapy and is asymptomatic without signs of SVC syndrome for 3 months. Discussion and conclusion This report illustrates a rare case of an invasive thymoma with extension to cardiac structures. Multimodality imaging for quality decision-making was imperative in the management and for surgical planning of this case. Transthoracic and transoesophageal echocardiography remain the exams of choice for the diagnosis of intracardiac disease. As demonstrated, a high index of suspicion is needed because clinical symptoms are unspecific and late diagnosis of potentially resectable tumors are associated with a poor prognosis. Abstract P1250 Figure. Multimodality imaging

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SUCK IT OUT! SUCCESSFUL REMOVAL OF INFECTED THROMBUS FROM THE SUPERIOR VENA CAVA USING THE PERCUTANEOUS ANGIOVAC SYSTEM

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)33681-0 ◽

2020 ◽

Vol 75 (11) ◽

pp. 3054

Author(s):

Abdur Rehman ◽

Archana Kodali ◽

Rudy Jordan Bohinc ◽

David Stultz ◽

Brian Schwartz

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Successful Removal

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Mediastinal Epithelioid Hemangioendothelioma Invading Superior Vena Cava: A Case Report and Review of Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180124141817 ◽

2019 ◽

Vol 15 (3) ◽

pp. 349-352

Author(s):

Su Hong Kim ◽

Young Seon Kim ◽

Min Hye Jang ◽

Hee Jung Kwon

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Anterior Mediastinum ◽

Epithelioid Hemangioendothelioma ◽

Vascular Neoplasm ◽

Case Presentation ◽

Contrast Enhanced ◽

The Right ◽

Brachiocephalic Veins

Introduction: Epithelioid Hemangioendothelioma (EHE) is a rare vascular neoplasm. Common locations of EHE are the bone, soft tissue, liver, and lung, but the mediastinal location is extremely rare. Few cases of mediastinal EHE, invading the Superior Vena Cava (SVC) have been reported. </P><P> Case Presentation: We report a case of a 21-year-old man with EHE invading the SVC, which was incidentally detected on performing chest radiography. A contrast-enhanced chest Computed Tomography (CT) scan demonstrated a well-defined, oval mass located on the right side of the anterior mediastinum. The mass showed homogeneous enhancement with punctate calcifications, and it invaded the SVC at the confluence area of the right and left brachiocephalic veins. Conclusion: Mediastinal EHE invading the SVC may present as a homogeneously enhancing mass with punctate calcifications. It should be added to the differential diagnosis of tumors of the mediastinum. Accurate preoperative diagnosis of EHE is critical for surgical planning; therefore, knowledge of the radiologic features of EHE is important.

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