scholarly journals Unusual Pharyngo-Esophageal Dysphagia Caused by a High-Riding Right Brachiocephalic Artery

2021 ◽  
Vol 45 (1) ◽  
pp. 79-82
Author(s):  
Ki Hoon Park ◽  
Sora Baek ◽  
Eun Kyoung Kang
Keyword(s):  
Filling Defect ◽  
Neck Mass ◽  
Solid Food ◽  
Brachiocephalic Artery ◽  
Food Bolus ◽  
Videofluoroscopic Swallowing Study ◽  
Esophageal Dysphagia ◽  
Left Neck ◽  
The Right ◽  
Cervical Area

High-riding right brachiocephalic and subclavian arteries are often asymptomatic and rare vascular variations. We present a patient with high-riding right brachiocephalic and subclavian arteries that caused compressive pharyngeal and cervical esophageal dysphagia. An 82-year-old woman presented to our hospital with dysphagia that worsened with solid food. A pulsatile lump was observed on the right neck side. A videofluoroscopic swallowing study showed a deviated food bolus movement anterolaterally from the normal vertical pharyngoesophageal transition, with a filling defect in the lower pharynx through the upper esophagus. Neck computed tomography (CT) showed high-riding right brachiocephalic and subclavian arteries and a tortuous right common carotid artery located adjacent to the trachea in the cervical area. The cervical midline structures were deviated to the left neck side. A neck mass with vascular variation should be considered as a cause of dysphagia that worsens with solid food; CT should be considered to determine its cause.

scholarly journals Undifferentiated Nasopharyngeal Carcinoma Presenting with Shoulder Mass

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Cosphiadi Irawan ◽  
Rahmat Cahyanur ◽  
Reyhan Eddy Yunus
Keyword(s):  
Palliative Chemotherapy ◽  
Nasopharyngeal Cancer ◽  
Bone Tumour ◽  
Undifferentiated Carcinoma ◽  
Neck Mass ◽  
Definitive Treatment ◽  
Unknown Primary ◽  
Common Cancer ◽  
Stage Ivb ◽  
The Right

Nasopharyngeal cancer (NPC) is the most common cancer among head and neck cancer that usually presented with unilateral neck mass. Unusual symptoms of NPC can lead us to diagnosis misleading and delayed definitive treatment. We present a case of NPC with bone metastasis in the shoulder. A 33-year-old female presented with right shoulder mass caused by undifferentiated carcinoma of unknown primary, based on biopsy of shoulder mass. After four months, she was complaining painless neck swelling, headache, and hearing impairment in the left ear. Bone MRI showed malignant bone tumour in the right humerus. Neck CT scan showed mass in the nasopharyngeal and bilateral lymphadenopathy. Biopsy in nasopharyngeal revealed undifferentiated carcinoma of nasopharyngeal cancer (WHO-3 type A). The patient was diagnosed as NPC stage IVb and thus was treated with palliative chemotherapy. After three cycles of cisplatin docetaxel, patient condition improved.

770 CONSIDERABLE EFFECT OF UPPER MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xiaojin Wang ◽  
Xiangfeng Gan ◽  
Qingdong Cao
Keyword(s):  
Perioperative Complications ◽  
Membrane Damage ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Anastomotic Strictures ◽  
Left Neck ◽  
The Right

Abstract   Conventional minimally invasive esophagectomy requires transthoracic surgery, which could increase the risk of many perioperative complications. Mediastinoscopy-assisted transhiatal esophagectomy has been proposed for years, but the traditional methods have shortcomings, such as unclear vision, especially during the dissection of upper mediastinal lymph nodes. We proposed a novel approach of upper mediastinal lymphadenectomy with mediastinoscopy through a left-neck incision, and investigated the effect of lymphadenectomy and other perioperative outcomes. Methods This approach for upper mediastinal lymphadenectomy includes three parts. (I) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) could be accomplished during esophagectomy under mediastinoscopy. (II) At the level of the lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, instruments are used to access the right RLN. Lymphadenectomy of up to 2 cm could be accomplished at the upper edge of the RSA. (III) Between the trachea and esophagus, the left and right main bronchi are exposed along the trailing edge of the trachea down to the carina, and lymphadenectomy can be performed here. Results This lymphadenectomy had been completed successfully on 117 patients, and 1 was converted to thoracotomy due to intraoperative tracheal membrane damage. The average operation time was 181.4 ± 43.2 minutes, bleeding volume was 106.4 ± 87.9 mL. The number of dissected LNs of upper mediastinal, the left RLN, the right RLN and the subcarinal was 11.2 ± 6.3, 5.1 ± 2.8, 3.2 ± 1.3 and 3.8 ± 2.1 respectively. 10 cases of (8.5%) anastomotic fistula were resolved with proper drainage and nutritional support. There were 25 cases (21.2%) of anastomotic strictures, 10 cases (8.5%) of pleural effusion, 20 cases (16.9%) of hoarseness. The incidence of hoarseness was 2.5% in three months postoperation. Conclusion These results showed that the lymphadenectomy through the left neck approach was not inferior than other surgical approaches in the amount of upper mediastinal LNs resection and perioperative outcome. Further research is needed to discover its impact on the long-term prognosis of ESCC patients.

scholarly journals Internal carotid artery “donut” aneurysm treated using derivo flow diverting stent

2021 ◽  
pp. 101-101
Author(s):  
Dragoslav Nestorovic ◽  
Igor Nikolic ◽  
Svetlana Milosevic-Medenica ◽  
Aleksandar Janicijevic ◽  
Goran Tasic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Decision ◽  
Filling Defect ◽  
Radiological Sign ◽  
Aneurysm Neck ◽  
The Right ◽  
Partial Thrombosis ◽  
Flow Diverting Stent

Introduction. Intracranial aneurysms with a radiological sign of a donut are a medical priority and have been described in a small number of cases. This radiological sign occurs in aneurysms in which there is partial thrombosis inside aneurismal sac and circular laminar flow between the aneurismal wall and the thrombus in its center. Consequently, there is a central contrast-filling defect of the aneurysm sac observed on different angiographic imaging methods. Case outline. We present a 35-year-old female patient was admitted for examination due to frequent headaches, visual disturbances on the left and loss of sight on the right eye. Digital subtraction angiography (DSA) showed an aneurysm on the right ICA measuring 25.6 ? 25 mm, while neck measured 11 mm and included part of the C6 and C7 segments. Treatment decision was made that positioning of flow diverting stent across the aneurysm neck would be most beneficial in this case. After procedure, patient was discharged in same general condition as she was before admission to the hospital. Seven months after the intervention, she reported for first digital DSA control. Normal position of the left A1was demonstrated, suggesting shrinkage of aneurysm sac. An improvement of vision on both eyes was stated. Conclusion. We present a patient with "donut" aneurysm on the internal carotid artery, successfully treated with flow diverting stent.

scholarly journals Anticoagulation may contribute to antimicrobial treatment of Lemierre syndrome: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jie Ge ◽  
Peipei Zhou ◽  
Yifei Yang ◽  
Tianshu Xu ◽  
Xu Yang
Keyword(s):  
Anticoagulation Therapy ◽  
Filling Defect ◽  
Antimicrobial Treatment ◽  
Lemierre Syndrome ◽  
Case Presentation ◽  
Intravenous Antibiotics ◽  
Left Neck ◽  
Wbc Count ◽  
Evidence Based Guidelines

Abstract Background Lemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial. Case presentation A 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution. Conclusions Our case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
X Wu ◽  
X Gan ◽  
Q Cao
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Laryngeal Nerve ◽  
Lower Edge ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

Case 7.1

2014 ◽  
pp. 307-309
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Solitary Kidney ◽  
Filling Defect ◽  
Microscopic Hematuria ◽  
Venous Phase ◽  
The Right

74-year-old man with a solitary kidney and new microscopic hematuria Coronal 2D fat-suppressed SSFP images (Figure 7.1.1) reveal a mass in the upper pole of the right kidney with heterogeneous expansile thrombus in the subhepatic and intrahepatic IVC. Note also the small, more hypointense filling defect in the IVC inferiorly just above the bifurcation, representing bland thrombus. Coronal venous phase 3D SPGR images (...

scholarly journals Pediatric Parathyroid Carcinoma: A Case Report and Review of the Literature

2019 ◽  
Vol 3 (12) ◽  
pp. 2224-2235 ◽  
Author(s):  
Aditya Dutta ◽  
Rimesh Pal ◽  
Nimisha Jain ◽  
Pinaki Dutta ◽  
Ashutosh Rai ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Parathyroid Carcinoma ◽  
Pediatric Population ◽  
Surgical Excision ◽  
Neck Mass ◽  
Hormone Levels ◽  
Metastatic Relapse ◽  
Right Lobe ◽  
The Right

Abstract Primary hyperparathyroidism (PHPT) is a rare endocrine disease in the pediatric population. Sporadic parathyroid adenomas remain the most common cause of pediatric PHPT. Parathyroid carcinoma (PC) is an extremely rare cause of pediatric PHPT. We report a 16-year-old boy presenting with a nonhealing fragility fracture of the right leg along with florid features of rickets. Examination revealed a neck mass, mimicking a goiter. Biochemical findings were consistent with PHPT. Imaging was suggestive of a right inferior parathyroid mass infiltrating the right lobe of thyroid. The patient underwent en bloc surgical excision of the parathyroid mass along with the right lobe of thyroid. Histopathology was suggestive of a PC. He achieved biochemical remission with normalization of serum calcium and parathyroid hormone levels. At follow-up, there was no biochemical or imaging evidence of recurrence or metastasis. Genetic analysis revealed heterozygous germline deletion of CDC73. An extensive literature search on PC was conducted, with an emphasis on the pediatric population. Thirteen cases of pediatric PC were identified. The median age of presentation was 13 years; there was no sex predilection. All cases were symptomatic; 31% had a visible neck mass. The median serum calcium and intact parathyroid hormone levels were 14.3 mg/dL and 2000 pg/mL, respectively. All patients underwent surgical excision, with 27% showing metastatic relapse. Our findings indicate that the preoperative features that could point toward a diagnosis of PC in a child with PHPT are a tumor size of >3 cm, thyroid infiltration on imaging, and severe hypercalcemia at presentation.

scholarly journals Extracranial invasion of a recurrent, transformed anaplastic pleomorphic xanthoastrocytoma: a case report

2018 ◽  
Vol 45 (S1) ◽  
pp. S2-S3
Author(s):  
K.D. Langdon ◽  
D. Krivosheya ◽  
M.O. Hebb ◽  
B. Wehrli ◽  
L.C. Ang
Keyword(s):  
Posterior Fossa ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Neck Mass ◽  
Pleomorphic Xanthoastrocytoma ◽  
Braf V600e ◽  
Rare Tumour ◽  
Who Grade ◽  
Original Tumour ◽  
The Right

Pleomorphic xanthoastrocytoma (PXA) is a rare tumour comprising <1% of all primary central nervous system tumours and the majority (~98%) occur supratentorially. We report on a 40-year-old female with a past medical history of a rare posterior fossa/cerebellar PXA who presented with a right-sided neck mass, decreased shoulder power and longstanding right tongue deviation with right-sided hemi-atrophy. The patient had prior tumour debulking. Recent MRI demonstrated an enhancing posterior fossa mass extending to the skull base at the jugular foramen and another mass in the upper neck along the jugular bulb with displacement and encasement of the right common carotid artery down to C5. Resection of the neck mass reveals an anaplastic PXA. The tumour has close approximation with adjacent peripheral nerves and is positive in 2 lymph nodes. Comparison with the original tumour molecular and immunohistochemical profiles reveals a conserved BRAF V600E mutation but the transformed malignant glioma now expresses dot-like EMA positivity and ATRX is completely lost (mutated). Transformation of a PXA (WHO Grade II) into an anaplastic PXA (WHO Grade III) has been well documented, but extracranial extension is extraordinarily rare. We report herein the first documented case of a posterior fossa PXA that underwent malignant transformation and extracranial invasion to the parapharyngeal space.

scholarly journals Thyroid haemangiosarcoma in a seven-year-old female Shih Tzu

2020 ◽  
Vol 8 (2) ◽  
pp. e001012
Author(s):  
Luis Pedro Rocha Moreira ◽  
Emma Scurrell ◽  
Paul Mahoney ◽  
Stephen Baines
Keyword(s):  
Histopathological Examination ◽  
Abdominal Ultrasound ◽  
Neck Mass ◽  
Clinical Staging ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
History Of ◽  
The Right ◽  
Mixed Tumours

Canine thyroid tumours are uncommon and the majority of tumours are carcinomas or adenomas, with only very few mixed tumours or metastases from distant sites described to date. A primary thyroid haemangiosarcoma has never been reported in veterinary medicine. In this case report, we describe a dog with a history of a large, non-painful, mobile ventral neck mass in the right paralaryngeal region. CT and ultrasound-guided fine needle aspirates were used for clinical staging. The mass was surgically excised and histopathological examination indicated a haemangiosarcoma. Abdominal ultrasound revealed the presence of splenic nodules and splenectomy indicated the presence of haemangiosarcoma. Chemotherapy with doxorubicin was started, but the dog was euthanased after three rounds of therapy, 97 days after the mass was discovered.

Intrathyroidal Parathyroid Cancer Presenting as a Left Neck Mass

Thyroid ◽  
1998 ◽  
Vol 8 (7) ◽  
pp. 597-599 ◽  
Author(s):  
DONALD G. CRESCENZO ◽  
MOHSEN SHABAHANG ◽  
DAVID GARVIN ◽  
STEPHEN R.T. EVANS
Keyword(s):  
Neck Mass ◽  
Parathyroid Cancer ◽  
Left Neck
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