7 DOACs: a new skyline in cancer-associated thrombosis resistant to heparin. A clinical case of seminoma in BEP chemotherapy protocol solved with edoxaban

Abstract Aims TEV is a common cancer complication with 20% incidence. LMWH is the standard therapy for efficacy, safety and ease of use. However, some scenarios are deeply challenging for intercurrent prothrombotic anticancer drugs. Methods A 35-year-old man reported dysphagia, EGDS: oesophagus ulcers, thyroid echography: thoracic mass compressing proximal borders. Vascular ultrasound: thrombosis of left internal giugular, subclavian, axillary and brachial veins; he began enoxaparin 6000 IU ×2/die (65 kg). CT-scan: solid anterior–superior mediastinum vascularized mass (16 × 13 cm) incorporating great thoracic vessels with 20 cm cranio-caudal longitudinal extension with trachea dislocation. PET-CT: massive superior-anterior mediastinum pathological 18F-FDG accumulation suggestive for malignancy. Lung perfusion scan: absence of left lung perfusion. Angio-CT: showed compression of pulmonary artery trunk and of branches. He presented marked asthenia, sweating and presyncope. D-dimer: 6026 µg/L, NT-proBNP: 1417 pg/mL. Mediastinum biopsy exhibited seminoma (ki67+: 65%), he started BEP Protocol (etoposide, cisplatin, bleomycin). TTE: periaortic cuff from mediastinum mass which ab extrinseco compressed pulmonary artery trunk and branches with occlusion of left one, right chambers dilatation, sovra-epatic veins and inferior vena cava (21 mm) ectasia, decreased inspiratory collapse, pulmonary hypertension (SPAP: 52 mmHg), EF: 55%. After 2 months of enoxaparin, vein ultrasound: persistent DVT and positive CUS. So, we replaced enoxaparin with edoxaban 60 mg/die. After 2 months of edoxaban, overall regression of vein thrombosis with minimal residual thrombosis of left internal giugular vein; D-dimer: 1554 µg/L. Results After 2 months of BEP Protocol, CT-scan: decrease mediastinum mass (6 × 12 cm) dimensions. Conclusions Cancer associated thrombosis is a frequent complication, worsening mortality, morbidity and decision-making. Cancer stage and drugs favour development of severe thrombosis, not solvable with LMWH, the cornerstone of anticoagulant therapy in cancer-related thrombosis. DOACs appear as a new and successful therapeutical option, especially in the most challenging cases of highly thrombotic profile after ‘heparin failure’.

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Rasmussen's Aneurysm Associate With Pulmonary Artery Vascular Malformation Presented With Haemoptysis

KYAMC Journal ◽

10.3329/kyamcj.v10i3.44424 ◽

2019 ◽

Vol 10 (3) ◽

pp. 168-170

Author(s):

Khaleda Parvin Rekha ◽

Umme Iffat Siddiqua ◽

Md Mofazzal Sharif ◽

Md Musharraf Husain ◽

Mohammad Abdus Salam

Keyword(s):

Pulmonary Artery ◽

Ct Scan ◽

Vascular Malformation ◽

Left Lung ◽

Lower Lobe ◽

Low Grade ◽

Imaging Department ◽

Increased Risk ◽

Risk Of Rupture ◽

Contrast Ct

Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery associated with a cavitary lung lesion. Like any aneurysm, a Rasmussen's aneurysm is at increased risk of rupture and bleeding into the lungs. A 52 years old male presented with low-grade fever and haemoptysis, chest x-ray revealed a well margined nodular shadow with calcifications in mid zone of left lung associated with ipsilateral upper zone fibrosis and bronchiectasis. The patient had past history of pulmonary tuberculosis eight years back. For characterization of left pulmonary nodule the patient was referred to radiology and Imaging department and contrast CT scan of chest was done. Contrast CT scan of chest with reformat MIP pulmonary angiogram revealed a small pulmonary artery vascular malformation in lateral basal segment of lower lobe of left lung associated with left upper lobar cavitating lesion with fibrosis, traction bronchiectasis and Rasmussen's aneurysm arising from upper lobar apical segmental pulmonary artery. Early surgical or angiographic interventions with endovascular embolization are recommended once it be clearly diagnosed. KYAMC Journal Vol. 10, No.-3, October 2019, Page 168-170

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Multidisciplinary surgical approach to renal cancer with vena cava invasion and pulmonary embolism

10.33699/pis.2021.100.2.88-93 ◽

2021 ◽

Vol 100 (2) ◽

Keyword(s):

Pulmonary Artery ◽

Inferior Vena Cava ◽

Ct Scan ◽

Renal Cancer ◽

Radical Nephrectomy ◽

Tumor Thrombus ◽

Inferior Vena ◽

Good Condition ◽

Vena Cava ◽

Surgical Removal

Introduction: Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called a tumor thrombus and is a locally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of a kidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. Case Reports: A 32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by a vascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in a good condition from the hospital. A 58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed a tumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery a temporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in a good condition. Conclusion: Surgical removal of renal tumor and tumor thrombus – radical nephrectomy with tumor thrombectomy – can be a curative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways – mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass – CPB) depending on the extent of the disease.

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Unintended Pulmonary Artery Ligation during PDA Ligation

The Heart Surgery Forum ◽

10.1532/hsf.1449 ◽

2016 ◽

Vol 19 (4) ◽

pp. 187 ◽

Cited By ~ 2

Author(s):

Dohun Kim ◽

Si-Wook Kim ◽

Hong-Ju Shin ◽

Jong-Myeon Hong ◽

Ji Hyuk Lee ◽

...

Keyword(s):

Pulmonary Artery ◽

Ductus Arteriosus ◽

Left Lung ◽

Left Pulmonary Artery ◽

Chest Ct ◽

Mechanical Ventilator ◽

Artery Ligation ◽

Ventilator Support ◽

Surgical Ligation ◽

Emergent Operation

A 10-day-old boy was transferred to our hospital due to tachypnea. Patent ductus arteriosus (PDA), 4.8 mm in diameter, with small ASD was diagnosed on echocardiography. Surgical ligation of the ductus was performed after failure of three cycles of ibuprofen. However, the ductus remained open on routine postoperative echocardiography on the second postoperative day, and chest CT revealed inadvertent ligation of the left pulmonary artery (LPA) rather than the PDA. Emergent operation successfully reopened the clipped LPA and ligated the ductus on the same (second postoperative) day.<br />Mechanical ventilator support was weaned on postoperative day 21, and the baby was discharged on postoperative day 47 with a normal left lung shadow.

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A rare case of right-sided varicocele in right renal tumor in the absence of venous thrombosis and IVC compression

African Journal of Urology ◽

10.1186/s12301-020-00072-3 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Priyabrata Adhikari ◽

Siddalingeshwar I. Neeli ◽

Shyam Mohan

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Renal Vein ◽

Renal Tumor ◽

Vena Cava ◽

Signs And Symptoms ◽

Spermatic Vein ◽

Careful Study ◽

Rare Presentation ◽

Grade 3

Abstract Background The presence of unilateral right-sided varicocele hints at a serious retroperitoneal disease such as renal cell neoplasm. Such tumors are usually associated with a thrombus in renal vein or spermatic vein. We report a rare presentation of right-sided renal tumor causing right-sided varicocele in the absence of thrombus in renal vein and spermatic vein but due to an anomalous vein draining from the tumor into the spermatic vein as demonstrated by computed tomography angiogram. Case presentation A 54-yr-old hypertensive male presented with unilateral grade 3 right-sided varicocele and no other signs and symptoms. Ultrasound examination of his abdomen showed the presence of a mass lesion in the lower pole of right kidney. Computed tomography confirmed the presence of right renal mass, absence of thrombus in right renal vein or inferior vena cava. The angiographic phase of CT scan showed an anomalous vein from the tumor draining into the pampiniform plexus causing varicocele. Conclusion The presence of right-sided varicocele should raise a suspicion hidden serious pathological retroperitoneal condition, renal malignancy in particular, and should prompt the treating physician to carry out imaging studies of the retroperitoneum and careful study of the angiographic phase of the CT scan can ascertain the pathogenesis of the varicocele.

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Specific airway management for SVC replacement during giant anterior mediastinal tumor resection

JA Clinical Reports ◽

10.1186/s40981-020-00377-w ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Izumi Kawagoe ◽

Daizoh Satoh ◽

Chieko Mitaka ◽

Masataka Fukuda ◽

Tsukasa Kochiyama ◽

...

Keyword(s):

Mediastinal Tumor ◽

Main Bronchus ◽

Superior Vena ◽

Tumor Resection ◽

Left Lung ◽

Vena Cava ◽

Double Lumen Tube ◽

Lower Airway ◽

Tumor Spread ◽

Anterior Mediastinal Tumor

Abstract Background Giant anterior mediastinal tumor (GAMT) resection is a challenging procedure, for which anesthesiologist might take to need special precautions. Case presentation A 48-year-old male patient had been scheduled to undergo GAMT resection and superior vena cava (SVC) replacement. The tumor spread surrounding SVC and left main bronchus (LMB), resulting in small volume of his left lung. A soft left-sided double lumen tube (DLT) was selected to keep the patency of LMB during left one lung ventilation (OLV) against the tumor weight. Semi-awake intubation with spontaneous breathing was selected for DLT insertion to avoid lower airway occlusion. During left OLV after right open thoracotomy, his SPO2 decreased below to 90%. We performed selective right upper lobe bronchial blockade using the combination of DLT and bronchial blocker. The surgery was successfully completed with this strategy. Conclusions Although such cases are rare, they are informative for anesthesiologists, providing optional strategies.

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Catheter-Based Dilation of the Sinus Ostia: Initial Safety and Feasibility Analysis in a Cadaver Model

American Journal of Rhinology ◽

10.2500/ajr.2006.20.2868 ◽

2006 ◽

Vol 20 (3) ◽

pp. 290-294 ◽

Cited By ~ 70

Author(s):

William E. Bolger ◽

Winston C. Vaughan

Keyword(s):

Ct Scan ◽

Safety Information ◽

Balloon Catheter ◽

Ease Of Use ◽

Sinus Surgery ◽

Human Cadaver ◽

Invasive Treatment ◽

Urologic Diseases ◽

Anatomic Dissection ◽

Catheter Technology

Background Over the past 20 years, many patients have benefited from endoscopic sinus surgery and its ability to relieve sinus obstruction. However, problems still occur with surgery, thereby leaving room for innovation. Recently, catheter-based technology has provided new options for treating cardiac, vascular, and urologic diseases. We speculated that catheter technology also might offer new treatment options for sinusitis patients. The purpose of this investigation was to explore the feasibility and safety of catheter-based technology to relieve sinus ostial obstruction. Methods Anatomic models and human cadaver specimens were used initially to design and iterate catheters to open sinus ostial drainage pathways. Thereafter, the safety of balloon-catheter dilation was evaluated in six human cadaver heads. CT scan obtained before and after catheter ostial dilation was analyzed for evidence of catheter-induced trauma. Dilated ostia also were examined by endoscopy and gross anatomic dissection for unwanted catheter-induced trauma. Results Catheters successfully dilated 31 of 31 ostia, including 9 maxillary, 11 sphenoid, and 11 frontal ostia/recesses. CT scan, endoscopy, and gross anatomic dissection revealed that such dilation did not cause trauma to surrounding structures such as the orbit or skull base. Mucosal trauma imparted by catheter dilation appeared to be less than that normally seen with standard endoscopic instruments. Conclusion This initial study suggests that catheter technology can be used to dilate sinus ostia safely. Mucosal preservation and ease of use make catheters an attractive minimally invasive treatment strategy. Additional testing in patients is indicated to gain additional safety information and to explore the usefulness of catheter-based technology.

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