Floating left innominate vein neoplastic thrombus: A rare case of mediastinal extension of follicular thyroid carcinoma

2013 ◽  
Vol 30 (2) ◽  
pp. 140-144 ◽  
Author(s):  
IF Franco ◽  
A Gurrado ◽  
G Lissidini ◽  
G Di Meo ◽  
A Pasculli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
En Bloc ◽  
First Case ◽  
Thyroid Mass ◽  
Retrosternal Goiter ◽  
Arm Swelling ◽  
Left Innominate Vein

Objective We report a case of advanced follicular thyroid cancer with innominate vein involvement. To our knowledge, this seems to be the first case treated in emergency surgery, reported in literature. Method A 59-year-old woman with a five-year history of a large and mainly right-sided cervical mass presented with dyspnea, unilateral arm swelling, facial flushing, and venous congestion. An emergency computed tomography scan revealed a thyroid mass extending into the upper mediastinum with displacement and compression of the right jugular vein and carotid artery and apparent adherence to the superior vena cava and left innominate vein. Results An emergency total thyroidectomy was performed by means of a sternotomy. The lower portion of the retrosternal goiter projected directly into the left innominate vein, with tumor floating in its lumen. Removal of the neoplastic thrombus was performed, through an incision in the vein, en bloc with the thyroid mass. Both goiter and thrombus were completely replaced by follicular carcinoma. Conclusions Accurate preoperative assessment through contrast-enhanced computed tomography is strongly suggested in the presence of enlarged thyroid gland extending into the mediastinum whenever angioinvasion is suspected. This could prevent blinded maneuvers such as digital externalization of the thoracic component of the gland, which can be fatal in cases of cervico-mediastinal goiter extending into great cervical or mediastinal veins.

A Giant Coronary Sinus Aneurysm with Secondary Vena Cava Aneurysms

2016 ◽  
Vol 19 (1) ◽  
pp. 028
Author(s):  
Shengjun Wu ◽  
Peng Teng ◽  
Yiming Ni ◽  
Renyuan Li
Keyword(s):  
Computed Tomography ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Unusual Case ◽  
Superior Vena ◽  
Vena Cava ◽  
Final Diagnosis ◽  
Rare Entity ◽  
First Case ◽  
Enhanced Computed Tomography

Coronary sinus aneurysm (CSA) is an extremely rare entity. Herein, we present an unusual case of an 18-year-old symptomatic female patient with a giant CSA. Secondary vena cava aneurysms were also manifested. The final diagnosis was confirmed by enhanced computed tomography (CT) and cardiac catheterization. As far as we know, it is the first case that such a giant CSA coexists with secondary vena cava aneurysms. Considering the complexity of postoperative reconstruction, we believe that heart transplantation may be the optimal way for treatment. The patient received anticoagulant due to the superior vena cava (SVC) thrombosis while waiting for a donor.

scholarly journals Incidental retroaortic innominate vein in a patient with acute aortic dissection

2020 ◽  
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
Cannulation Site ◽  
Left Innominate Vein ◽  
Retroaortic Innominate Vein ◽  
Hemiarch Replacement

Abstract BackgroundRetroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare.Case presentationA 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement. ConclusionsAttention must be paid to the cannulation site for venous uptake and the method of myocardial protection.

scholarly journals Incidental Retroaortic Innominate Vein in a Patient with Acute Aortic Dissection

2020 ◽  
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
Cannulation Site ◽  
Left Innominate Vein ◽  
Retroaortic Innominate Vein ◽  
Hemiarch Replacement

Abstract BackgroundRetroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare.Case presentationA 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement. ConclusionsAttention must be paid to the cannulation site for venous uptake and the method of myocardial protection.

scholarly journals Incidental retroaortic innominate vein in a patient with acute aortic dissection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hideki Sasaki ◽  
Takashi Harada ◽  
Hiroshi Ishitoya ◽  
Osamu Sasaki
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
Cannulation Site ◽  
Left Innominate Vein ◽  
Retroaortic Innominate Vein ◽  
Hemiarch Replacement

Abstract Background Retroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare. Case presentation A 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement. Conclusions Attention must be paid to the cannulation site for venous uptake and the method of myocardial protection.

scholarly journals Venous Thrombosis of the Mammary Vein Following Peripherally Inserted Central Catheter for Total Parenteral Nutrition Relying on Ecg Tip Confirmation Technology

2021 ◽  
pp. 1-4
Author(s):  
Aravind R Kuchkuntla ◽  
◽  
Manpreet S Mundi ◽  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Superior Vena ◽  
Vena Cava ◽  
Innominate Vein ◽  
Life Saving ◽  
Internal Mammary ◽  
Chest X Ray ◽  
Tip Position ◽  
Left Innominate Vein

Total parenteral nutrition (TPN) is a life-saving therapy for patients who are not able to utilize the gastrointestinal tract. There are several different types of central venous catheters (CVC) used to deliver TPN. To safely deliver hyperosmotic TPN solutions, CVC tip position should be in the in lower superior vena cava (SVC) or at the junction of SVC and right atrium (RA). New techniques such as intravascular electrocardiogram (ECG) are being used for tip confirmation to help facilitate expedient use of PICC lines replacing the need for chest x-ray (CXR) confirmation. We present a case of a TPN patient who had a PICC line placed, and ECG confirmed tip as being in the SVC. The patient developed chest pain with flushing of the PICC prompting surgical service to obtain a CXR. The CXR suggested the line was in the either in mammary vein or aorta and recommended replacement. Interventional radiology flushed a small amount of contrast through the PICC and fluoroscopy confirmed the PICC tip was in the left internal mammary vein with reflux of contrast in the left innominate vein. The left innominate vein was occluded due to thrombosis and vasospasm. The patient required increased level of care (PCU) for 2 days, but was eventually discharged with home total parenteral nutrition and has done well. We conclude that care should be taken when using ECG confirmation for PICC tip placement and we feel that patients requiring hyperosmotic TPN should still require CXR confirmation to ensure tip appropriate tip location

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