Surgical resection of large anterior mediastinal masses: Results of median sternotomy approach.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20005-e20005
Author(s):  
Raj Mohan
Keyword(s):  
Superior Vena ◽  
Germ Cell Tumors ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Postoperative Mortality ◽  
Surgical Approaches ◽  
Femoral Access ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Cardiac Bypass

e20005 Background: Anterior mediastinal masses are a diverse group of tumors generally presenting as compressive symptoms. Larger masses require open surgical approaches including median sternotomy or sterno-thoracotomy. In this study we analyzed the surgical and pathological outcomes of large anterior mediastinal masses resected through sternotomy approach. Methods: Data of 16 patients with anterior mediastinal masses ( > 10 cms) treated surgically was analyzed retrospectively. All the patients were evaluated preoperatively with MRI, CT guided biopsy and pulmonary function test followed by exploration through median sternotomy approach with/without cardiac bypass (through femoral access). Adjuvant chemo-radiation was used according to histopathological features. Results: A total of 10 male and 6 females with median age 42 years (range: 6-62) underwent resection. Three patients received neoadjuvant chemotherapy and the mean tumor size was 12.2 cms. Histopathologies included mature teratomas/dermoids (4), thymic carcinoma (3), nerve sheath tumors (3), malignant germ cell tumors (3), synovial sarcoma (1) primary mediastinal goiter (1) and inflammatory pseudo tumor (1). There was no postoperative mortality and two patients required cardiac bypass. Bovine pericardium was used in two patients for the loss of large are of pericardium. One patient required biograft for replacement of resected superior vena cava. Major morbidities included prolonged ventilation and intrathoracic collection in two patients. All the patients were disease free after a median follow up of 14 months. Conclusions: Large anterior mediastinal masses are challenging surgically. An aggressive surgical approach through median sternotomy in association with cardiac bypass helps in complete resection and may lead to optimal results.

Clinicopathological Spectrum of Mediastinal Mass Lesions - A Cross-Sectional Study of 58 Cases in Kolkata, West Bengal

2021 ◽  
Vol 8 (25) ◽  
pp. 2180-2186
Author(s):  
Debarati Pathak ◽  
Abhijit Banerjee ◽  
Soma Ghosh ◽  
Arghya Bandyopadhyay ◽  
Tushar Kanti Das
Keyword(s):  
Germ Cell ◽  
Superior Vena ◽  
Vena Cava ◽  
Histopathological Study ◽  
Anatomical Location ◽  
Germ Cell Tumours ◽  
Surgical Biopsy ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Neoplastic Lesions

BACKGROUND Mediastinal masses, an enigma to surgical pathologist are among the most complicated lesions explored and relatively inaccessible. They often connote a process with mass effect presenting with superior mediastinal syndrome. This is a challenging area faced by surgical pathologist as varied lesions are found here and often biopsies obtained are tiny and crushed. Appropriate therapy of various mediastinal tumours differs considerably and may significantly impact survival. We wanted to evaluate the various lesions in different compartments of mediastinum and categorise them according to anatomical location, and histopathology. METHODS Patients with mediastinal masses attending outpatient department were selected, history taken and relevant investigations done with radiological evaluation for proper anatomical location of lesion. Histopathological study done on tissues obtained by ultrasound / CT guided biopsy, open surgical biopsy were categorized according to histologic types. Immunohistochemistry was done wherever applicable. RESULTS A total of 58 cases of mediastinal lesions were studied where males predominated and age of patients ranged from 11 months to 68 yrs. All patients were symptomatic. Shortness of breath, superior vena cava syndrome was dominant in anterior and superior mediastinal lesions, middle and posterior mediastinal masses presented with chest pain. Most lesions were neoplastic. Germ cell tumours were found in (24.14 %) followed by lymphoma in (20.69 %) and thymic lesions in (18.97 %) of patients. Neurogenic tumours found in (13.79 %) were located in posterior mediastinum whereas, germ cell tumours and lymphomas were located in anterior mediastinum. Non neoplastic lesions included tuberculosis, sarcoidosis. Unsuspected lesion was metastatic deposit of adenoid cystic carcinoma. CONCLUSIONS A wide variety of non-neoplastic and neoplastic lesions can be found in different compartments of mediastinum and accurate diagnosis is considered necessary to formulate management strategies. KEYWORDS Mediastinum, Biopsy, Radiology, Histopathology

scholarly journals A study of mediastinal tumours in a tertiary care centre: a retrospective study

2021 ◽  
Vol 9 (3) ◽  
pp. 862
Author(s):  
Kaladhar Bomma ◽  
Amaresh R. Malempati
Keyword(s):  
Myasthenia Gravis ◽  
Clinical Presentation ◽  
Lung Metastases ◽  
Superior Vena ◽  
Tertiary Care ◽  
Vena Cava ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Residual Tumour ◽  
Mediastinal Masses

Background: Recent advances in diagnostic and surgical techniques have brought major changes in the clinical presentation, diagnosis and the surgical management of mediastinal masses. Indian literature in this scenario is deficient, which our retrospective descriptive study aims to address.Methods: Details of patients operated for mediastinal masses from January 2007 November 2013 in two units at NIMS were collected. Clinical presentation, symptomatology, radiological/pathological findings, surgical approaches, intraoperative/immediate/intermediate post-operative results were evaluated and analysed.Results: Of the 75 patients, (48 males, range 10 years to 65 years) 2 deaths were due to complications following exacerbation of myasthenia gravis, and two patients died due to post-operative bleeding. Thymicneoplasms were the most common, followed by neurogenic tumours. Most common presentation was myasthenia gravis, followed by nonspecific back pain. 4% of patients had symptoms due to local compressive effects. Tumour was in the anterior mediastinum, middle and posterior mediastinum in 53, 16 and 6 cases respectively. Surgery done with a curative intent was through sternotomy (59), posterolateral thoracotomy (14), and combined sternotomy and cervical route (2). Residual tumour was present in 5 cases due to nerve involvement. Follow up was 98% (2 months to 6 years). 3 patients died of unrelated causes and one developed multiple lung metastases. 2 patients with neurogenic tumours developed recurrence.Conclusions: Inadequately optimized myasthenia patients and superior vena cava obstruction are poor prognostic factors. Complete excision may not be possible in neurogenic extension to spine even with concomitant neurosurgery. Neurological infiltration has a poorer prognosis.

scholarly journals Successful Resection of a Giant Pulmonary Colloid Adenocarcinoma via Median Sternotomy

2020 ◽  
Vol 13 (3) ◽  
pp. 1097-1102
Author(s):  
Daisuke Nakamura ◽  
Ryoichi Kondo ◽  
Akiko Makiuchi ◽  
Hiroko Itagaki
Keyword(s):  
Superior Vena Cava ◽  
Lung Tumor ◽  
Mediastinal Lymph Node ◽  
Superior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Cystic Mass ◽  
Field Of View ◽  
Surgical Field ◽  
The Right

We report on a giant pulmonary colloid adenocarcinoma successfully resected using a median sternotomy approach. A 69-year-old woman visited our hospital owing to a giant mass detected on chest radiography. A giant cystic mass measuring 115 × 90 mm was detected in the right upper lung using computed tomography. We suspected mucinous adenocarcinoma and performed right upper lobectomy and mediastinal lymph node dissection with median sternotomy. The surgical field of view for the tumor and superior vena cava was satisfactory, and compression but not invasion of the superior vena cava and chest wall by the tumor was observed. The tumor was pathologically diagnosed as a colloid adenocarcinoma of stage IIIA with pT4N0M0. The postoperative course was uneventful, with no signs of recurrence at one and a half years after operation. Thus, this case demonstrates that for giant lung tumor surgery, median sternotomy is useful and safe for improving the surgical field of view.

scholarly journals Advantages and disadvantages of femoral port systems in hematоlogical patients with superior vena cava syndrome

2020 ◽  
Vol 65 (4) ◽  
pp. 403-416
Author(s):  
G. M. Galstyan ◽  
M. V. Spirin ◽  
M. Yu. Drokov ◽  
I. E. Kostina ◽  
Ya. K. Mangasarova
Keyword(s):  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Complication Rates ◽  
Femoral Access ◽  
Advantages And Disadvantages ◽  
Vena Cava Syndrome

Background. In the superior vena cava syndrome, vein catheterisation provides an alternative for vascular access. Few reports describe the usage of femoral ports.Aim. Description of pros and contras for femoral port installation in patients with haematological malignancies and the superior vena cava syndrome.Materials and methods. This prospective non-randomised, single-centre study included 163 haematological patients implanted 72 ports in superior vena cava, 35 — in inferior vena cava and inserted with 156 non-tunnelled femoral catheters. Catheterisation properties, complications, duration of use and reasons for port and catheter removal were registered.Results. No significant differences were observed between ports in superior and inferior vena cava as per the frequency of urokinase use in catheter dysfunction, catheter dislocation, catheter-associated bloodstream and pocket infections. Differences were revealed in the catheter-associated thrombosis rate, which was higher with femoral access (17.0 % or 0.9/1000 catheter days vs. 8.3 % or 0.2/1000 catheter days, p = 0.017). Ports in inferior vena cava had a lesser duration of use than in superior vena cava (p = 0.0001). Unlike femoral ports, non-tunnelled femoral catheters had higher rates of catheter-associated thrombosis (9/1000 vs. 0.9/1000 catheter days, p = 0.002) and infection (4.9/1000 vs. 0.3/1000 catheter days, p = 0.002). One lymphoma therapy course required one femoral port or 1 to 14 (median 3) non-tunnelled femoral catheters.Conclusion. Femoral port implantation is a necessary measure in patients with the superior vena cava syndrome. It has advantages in terms of catheterisation frequency, lower infectious and thrombotic complication rates compared to non-tunnelled femoral catheters.

scholarly journals Failure of Femoral Access to Electrophysiological Evaluation Due to Aplasia of the Inferior Vena Cava

2016 ◽  
Vol 10 ◽  
pp. CMC.S38153
Author(s):  
Mariana S. Parahuleva ◽  
Mehmet Burgazli ◽  
Nedim Soydan ◽  
Wolfgang Franzen ◽  
Norbert Guttler ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Azygos Vein ◽  
Interesting Case ◽  
Hepatic Veins ◽  
Femoral Access

We report an interesting case of a man with a persistent left superior vena cava (PLSVC) with left azygos vein who underwent electrophysiological evaluation. Further evaluation revealed congenital dilated azygos vein, while a segment connecting the inferior vena cava (IVC) to the hepatic vein and right atrium was missing. The azygos vein drained into the superior vena cava, and the hepatic veins drained directly into the right atrium. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature.

Utility of transesophageal echocardiography in the assessment of mediastinal masses and superior vena cava obstruction

1991 ◽  
Vol 122 (5) ◽  
pp. 1469-1472 ◽  
Author(s):  
Phillip R. Dawkins ◽  
Marcus F. Stoddard ◽  
Norman E. Liddell ◽  
Rita Longaker ◽  
David Keedy ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Superior Vena Cava Obstruction ◽  
Mediastinal Masses

scholarly journals Management of Chronic Pacemaker Lead Infection, Superior Vena Cava Obstruction and Tricuspid Valve Endocarditis (Operative Technique and a Case Report

2015 ◽  
Vol 22 (1) ◽  
pp. 45-51
Author(s):  
Husain H. Jabbad
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Pulse Generator ◽  
Superior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Cardiac Pacemaker ◽  
Low Grade ◽  
Pacemaker Lead ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker

A 73 year old female presented with the diagnosis of infected cardiac pacemaker. She had complete heart block 2.5 years ago, a permanent dual chamber pacemaker was inserted via a left subclavian approach and the pulse generator positioned in the left clavipectoral fascia. In the early post operative period she developed fever with a clear pacemaker pocket infection, treated with intravenous antibiotics. The initial pacemaker was removed, the pocket cleaned and closed and a new dual-chamber pacemaker inserted in the right clavipectoral area via right subclavian approach. She was kept on a prolonged antibiotics course of vancomycin and gentamicin because of sepsis and blood cultures results of Pseudomonas aeruginosa. On presentation she had diabetes insipidus, recurrent low grade fever and impaired renal function, the pacemaker was functioning well and she was still on IV vancomycin. Investigations revealed a large intra-atrial clot attached to the pacemaker lead, the pacemaker and infected intravascular component were removed via median sternotomy and new pacemaker inserted with epicardial atrial and ventricular leads. The intra-operative cultures grow Pseudomonas aeruginosa treated with 6 weeks of intravenous Tazocin, follow-up for 9 months with no recurrent pocket or deep infection and good functioning pacemaker.  

scholarly journals Sequential Treatment of Superior Vena Cava Syndrome Caused by of Non-small Cell Carcinoma Lung Cancer (NSCLC) with Vascular Stenting and Iodine-125 Implantation

2009 ◽  
Vol 8 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Lianxiang Xiao ◽  
Zhenjia Li ◽  
Lebin Wu ◽  
Zengtao Sun ◽  
Xianghong Yu
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Symptom Relief ◽  
Vena Cava ◽  
Sequential Treatment ◽  
Endovascular Stenting ◽  
Ct Guided ◽  
Vena Cava Syndrome ◽  
Iodine 125

Feasibility and efficacy of sequentially performed endovascular stenting and Iodine-125 brachytherapy for malignant superior vena cava syndrome (SVCS) were evaluated. Thirty-four patients with malignant SVCS caused by NSCLC underwent sequential treatment of endovascular stenting and Iodine-125 brachytherapy. SVCS was diagnosed in all patients by CT images or vena-cavography. Pathology diagnosis was acquired by image guided biopsy. Endovascular stent placement was performed as first-line treatment for symptom relief. CT-guided Iodine-125 seed implantation performed 24hr after stenting. Clinical end points were resolution of symptoms and local efficacy of primary malignancy regression. Symptom relief rate was >90% after 24hr and 97% after 3 months. No migration of seeds or restenosis occurred in any patient. The local efficacy (defined as either partial or complete response) was 53%, 79%, 88% and 74% after 1, 3, 6 and 12months, respectively. Mean SVCS-free survival time was 305 days (range 120–960 days). Two patients were still alive at the time of this writing, Thirty-one died from progression and one died from acute heart disease. Sequentially performed endovascular stenting and Iodine-125 brachytherapy provides a safe and effective alternative for malignant SVCS caused by NSCLC.

scholarly journals Primary malignant teratoma of the mediastinum with poor outcome: A case report

2018 ◽  
Vol 75 (8) ◽  
pp. 836-840
Author(s):  
Danica Sazdanic-Velikic ◽  
Dusan Skrbic ◽  
Djordje Povazan ◽  
Mirna Djuric ◽  
Dejan Vuckovic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Ct Scan ◽  
Superior Vena ◽  
Germ Cell Tumors ◽  
Disease Patient ◽  
Vena Cava ◽  
Whole Body ◽  
Malignant Teratoma ◽  
Mediastinal Tumors

Introduction. About 5%?10% of mediastinal tumors in adults are teratomas and about 85% of them are benign. Case report. We report a case of extragonadal malignant teratoma in a 39-year old man. The computed tomography (CT) scan of the chest revealed the soft-tissue density mass in the middle lobe of the lung. The posterolateral thoracotomy was performed and a mediastinal tumor of 25 cm was completely resected. Histopathological findings confirmed malignant teratoma. One month after the resection the positron emission tomography- computed tomography (PET/CT) scan of the whole body was performed and showed progression of the disease. Patient developed signs of the superior vena cava obstruction and received radiotherapy of the mediastinum and the metastatic lesion of the lumbal vertebra. After radiotherapy, the patient developed paraplegia and urinary incontinence and received the best supportive treatment. Conclusion. Primary extragonadal germ cell tumors have poor prognosis due to their relative chemoresistance and frequent findings of advanced disease after establishing the diagnosis.

scholarly journals Superior vena cava syndrome caused by epitheloid hemangioma

2005 ◽  
Vol 62 (5) ◽  
pp. 409-412
Author(s):  
Radoje Ilic ◽  
Zoran Trifunovic ◽  
Vladimir Mandaric ◽  
Svetislav Tisma
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Uneventful Recovery ◽  
Complete Disappearance ◽  
Vena Cava Superior ◽  
Vena Cava Syndrome ◽  
Symptoms And Signs

Aim. A case is presented of the surgical treatment of epitheloid hemangioma as a rare cause of superior vena cava syndrome. Case report. A 53-year old woman was admitted to the clinic with the symptoms and signs of superior vena cava syndrome. After clinical evaluation and diagnostic tests, she was operated on through median sternotomy, and the desobliteration of the superior vena cava through longitudinal ca votomy was done. After the desobliteration by the removal of benign tumor from its cavity, vena cava was reconstructed with the continuous prolen suture. Pathohistologicaly, there was the evidence of epitheloid hemangioma that made the subtotal obliteration of the vena cava superior by its expansive growing at the entry in the right atrium. Postoperatively, there was a complete disappearance of the symptoms and signs of superior vena cava syndrome. After an uneventful recovery, the patient was discharged from the hospital.

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