scholarly journals Cardiopulmonary Arrest Caused by Large Substernal Goiter—Treatment with Combined Cervical Approach and Median Mini-Sternotomy: Report of a Case

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 303
Author(s):  
Charilaos Koulouris ◽  
Aristoklis Paraschou ◽  
Vasiliki Manaki ◽  
Stylianos Mantalovas ◽  
Kassiani Spiridou ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Arrest ◽  
Superior Vena ◽  
Vena Cava ◽  
Rare Condition ◽  
Ct Imaging ◽  
Thoracic Inlet ◽  
Substernal Goiter ◽  
Cervical Approach ◽  
Thoracic Approach

Introduction: Substernal goiter is usually defined as a goiter that extends below the thoracic inlet or a goiter with more than 50% of its mass lying below the thoracic inlet. Substernal goiters may compress adjacent anatomical structures causing a variety of symptoms. Case report: Here we report a rare case of a 75-year-old woman presenting with cardiac arrest caused by acute respiratory failure due to tracheal compression by a substernal goiter. Discussion: Substernal goiters can be classified as primary or secondary depending on their site of origin. Symptoms are diverse and include a palpable neck mass, mild dyspnea to asphyxia, dysphagia, dysphonia, and superior vena cava syndrome. Diagnosis of substernal goiter is largely based on computed tomography imaging, which will show the location of the goiter and its extension in the thoracic cavity. Surgery is the treatment of choice for symptomatic patients with substernal goiter. The majority of substernal goiters are resected through a cervical approach. However, in approximately 5% of patients, a thoracic approach is required. The most important factor determining whether a thoracic approach should be used is the depth of the extension to the tracheal bifurcation on CT imaging. Conclusion: Cardiac arrest appearing as the first symptom of a substernal goiter is a very rare condition and should be treated by emergency thyroidectomy via a cervical or thoracic approach depending on the CT imaging findings.

scholarly journals Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987921
Author(s):  
Edwin Kean Siong Ong ◽  
Tat Seng Wong ◽  
Weng Hong Chung ◽  
Chee Kidd Chiu ◽  
Aik Saw ◽  
...  
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Rare Condition ◽  
Posterior Spinal Fusion ◽  
Brachiocephalic Vein ◽  
Left Brachiocephalic Vein ◽  
Significant Correction ◽  
Upper Thoracic ◽  
Neurovascular Structures ◽  
Fibula Strut

Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.

The Use of CT Imaging Technology in Peripherally Inserted Central Catheter

2021 ◽  
Vol 11 (1) ◽  
pp. 114-119
Author(s):  
Ying Wu ◽  
Guohua Huang ◽  
Qiufeng Li ◽  
Jinai He
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Ct Imaging ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Imaging Technology ◽  
X Ray ◽  
The Right

Objective: The objective is to explore the application of computed X-ray tomography (CT) imaging technology in peripherally inserted central catheter (PICC), and to propose a more effective method for PICC catheterization. Method: In this study, 69 subjects are divided into the observation group (X-ray and CT) and the control group (X-ray). The guiding effect of CT images on PICC tube placement in complex cases is compared. In this study, CT localization of the superior vena cava–caval-atrial junction (CAJ) is used as the gold standard. The position relationship of carina-CAJ and carina-PICC catheter tip is measured and analyzed by CT image and chest radiography (CXR) image, providing scientific basis for PICC tip imaging. Results: After this study, the tip of the catheter should be 1/3 of the middle and lower part of the superior vena cava, about 3 cm above the junction of the right atrium and the superior vena cava, and in the upper part of the diaphragm of the inferior vena cava, so that it cannot enter the right ventricle or the right atrium. The best position of the tip of the catheter is near the junction of the superior vena cava and the right atrium. The average vertical distance between the tracheal carina and CAJ is 4.79 cm. Conclusion: CT and X-ray examination can effectively determine the location of the tip of PICC catheter in cancer chemotherapy patients, but the clarity of X-ray examination is missing. It is suggested to adopt CT examination, and further adopt and promote it.

Superior Vena Cava Syndrome and Substernal Goiter

Thyroid ◽  
2010 ◽  
Vol 20 (2) ◽  
pp. 235-236 ◽  
Author(s):  
Mafalda Marcelino ◽  
Ema Nobre ◽  
João Conceição ◽  
Luis Lopes ◽  
Helena Vilar ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Substernal Goiter ◽  
Vena Cava Syndrome

Giant saccular superior vena cava aneurysm: a rare clinical case

2020 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Surgical Treatment ◽  
Superior Vena Cava ◽  
Clinical Case ◽  
Medical Literature ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Presentation ◽  
Vena Cava Syndrome

Background: Superior vena cava (SVC) aneurysm is a rare clinical disease. Only around 50 cases have been reported in the medical literature. Case presentation: We report a 22-year-old man with SVC aneurysm with cardiac arrest as the first symptom accompanied by typical superior vena cava syndrome. Conclusion: We suggest that patients with giant SVC aneurysm should avoid sudden changes in posture, and that surgical treatment should be implemented urgently.

scholarly journals Challenges of Cardiopulmonary Resuscitation during Pregnancy

2019 ◽  
Vol 04 (01) ◽  
pp. 032-039
Author(s):  
Padmaja Durga ◽  
Shibani Padhy ◽  
Anupama Bardaa
Keyword(s):  
Cardiac Arrest ◽  
Pregnant Woman ◽  
Cardiopulmonary Resuscitation ◽  
Cricoid Pressure ◽  
Cardiopulmonary Arrest ◽  
Vena Cava ◽  
Spontaneous Circulation ◽  
Gravid Uterus ◽  
Rapid Sequence Intubation ◽  
Team Approach

AbstractCardiac arrest, though rare, is the most feared complication in the pregnant woman as it involves two lives. Most arrests occur because of conditions that result from the pregnancy itself or from preexisting medical conditions exacerbated by the pregnancy. Prompt resuscitative efforts are crucial for favorable outcomes for the mother and fetus. The basic principles of resuscitation during pregnancy such as airway, breathing, and circulation are similar to the resuscitation in a cardiopulmonary arrest in any patient; however, certain modifications are necessary to account for the physiologic changes that occur during the pregnancy. Cardiopulmonary resuscitation (CPR) of the parturient should include uterine tilt or displacement to relieve the compression of the inferior vena cava and aorta by the gravid uterus, intubation using rapid sequence intubation with cricoid pressure, and timely perimortem cesarean section (PMCS). Ideally, the PMCS must be performed within 5 minutes of cardiac arrest if the pregnant woman does not have a return of spontaneous circulation, and resuscitation is deemed unsuccessful. The PMCS is performed if the gestational age is at least 20 weeks or the gravid uterus is evident. A high-quality CPR and multispecialty team approach, consisting of obstetricians, cardiologists, anesthesiologists, neonatologists, and nursing staff, is essential for survival.

Critical Airway Obstruction, Superior Vena Cava Syndrome, and Spontaneous Cardiac Arrest in a Child With Acute Leukemia

2005 ◽  
Vol 21 (12) ◽  
pp. 844-846 ◽  
Author(s):  
Kam-lun Ellis Hon ◽  
Alex Leung ◽  
Ki-wai Chik ◽  
Chiu-wing Winnie Chu ◽  
Kam-lau Cheung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Acute Leukemia ◽  
Airway Obstruction ◽  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Vena Cava Syndrome

Substernal Goiter: Correlation between Grade and Surgical Approach

2018 ◽  
Vol 84 (2) ◽  
pp. 262-266
Author(s):  
Karla V. ChÁVez Tostado ◽  
David VelÁZquez-Fernandez ◽  
MÓNica Chapa ◽  
Juan P. Pantoja MillÁN ◽  
Mauricio S. Salazar ◽  
...  
Keyword(s):  
Cross Section ◽  
Surgical Approach ◽  
Thoracic Inlet ◽  
Partial Sternotomy ◽  
Substernal Goiter ◽  
Cervical Approach ◽  
Grade Ii ◽  
The Cross ◽  
Ct System ◽  
Grade Iii

Substernal goiter is defined as a thyroid growth beyond the thoracic inlet. Using the cross-section imaging CT system, it can be classified into three grades. The aim of the study was to validate the surgical approach and the occurrence of postoperative complications with substernal goiter extension in our patient population. From a total of 1145 patients who underwent thyroid surgery at our institution in a 15-year period, 60 patients with substernal goiter were included. Clinical features and demographics, degree of extension, surgical details, and complications were analyzed. Mean ± SD age of the patients was 58 ± 14.7 years and 88 per cent were females. According to the cross-section imaging CT system 61.7 per cent were grade I,23.3 per cent grade II, and 15 per cent grade III. Total thyroidectomy was performed in 78.3 per cent of the patients, subtotal thyroidectomy in 18.3 per cent, and lobectomy in 3.3 per cent. The cervical approach was sufficient to perform 96.7 per cent of the thyroidectomies, requiring partial sternotomy in only two patients with grade III substernal goiter. Patients with grade III substernal goiter had a higher risk for postoperative dysphonia (OR = 14.29, IC95% 1.14-178.9, P = 0.03), which occurred in three patients (two transient and one permanent). Transitory hypoparathyroidism was present in 20 patients (33.3%) and did not correlate with goiter extension. Most substernal goiters can be resected through a cervical approach, with relatively low morbidity. Postoperative dysphonia was directly related to the extension of the goiter. Few cases with grade III goiters require a partial sternotomy.

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